A trend analysis of perinatal mortalities in Barberton Hospital between 2002 and 2016
- Modupe, Oluwarotimi Folorunsho
- Authors: Modupe, Oluwarotimi Folorunsho
- Date: 2018
- Subjects: Newborn infants -- Mortality Perinatology
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/11254 , vital:37630
- Description: Background and aim: There is no doubt that the quantification of data on the new born is imperative towards the design of effective public health policy interventions. However, the trend in under-five mortality rates in Barberton Hospital is not recognised as no empirical investigation has been undertaken to ascertain its position in this regard. A trend analysis of infant and maternal deaths in will therefore shed light on possible factors influencing this trend. The specific objectives of this study were to examine the trend and causes of perinatal mortality in Barberton Hospital from 2002-2016. It was hypothesized that there would be a downward trend in the infant and maternal mortality rates in Barberton Hospital from 2002-2016, possibly as a result of improved medical care. Methods: This retrospective study was conducted in Barberton Hospital, located in the Umjindi sub-district in Mpumalanga Province. The data was drawn from the Perinatal Problem Identification Programme (PPIP) database. Pregnancy related deaths of women, and of children from birth to one year in Barberton Hospital from 1999-2014 were extracted. The population study consists of a record review of all infant and maternal deaths in Barberton Hospital from 2002-2016 and captured in the data on the PPIP. The University of Fort Hare ethical review committee approved the study protocol. In addition, permission to use the data was granted by the Mpumalanga Department of Health after applying for approval for use of the data for academic purposes. The data was then exported into an Excel format document and fed to Statistical Package for Social Sciences (SPSS) program to allow for a more detailed analysis. Results: Over the period under review (2002-2016), a total of 21151 babies were delivered, 20593 babies were alive at discharge, 221 babies died in the first 28 days of delivery, and 337 babies were stillbirths. 18577 were normal weight (≥2500gram), 1581 weighed 2000-2499 grams, 568 weighed 1500-1999grams, 286 weighed 1000-1499 and 139 weighed below 1000grams. All the women who gave birth over the period under review, 27.3percent tested positive to HIV, 40.3 percent tested negative. Of all women that tested positive, 80.2percent received any form of ART. For over half of women that received ART (n=2981), the type of ART they received is unknown. Most women whose baby died were young. One in five women did not have their age captured in the database indicating an important gap that need to be addressed in order to ensure integrity of the database. Of all the 558 perinatal mortality, 75.3 weighed below 2500 grams. Low birth weight is major risk factor for child mortality. Babies weighing less than 2,500 grams are 20 times more likely to die than heavier babies. For all the perinatal deaths, the majority of their mothers received antenatal care services. About 86.6percent were delivered at Barberton Hospital and only 1 child was delivered in transit to the hospital. Of all the 558 deaths, only 7.5 percent was multiple births. Of the 558 babies that died, only 39.6percent were born alive, 37.1percent was macerated stillbirths. The syphilis serology test indicated that most mothers tested negative. The HIV serology test indicated that 28percent of mothers tested positive. The hospital recorded a total of 337 stillbirths between 2002 and 2016. This accounts for 60.2percent of all perinatal mortality over the period. Of all stillbirths, 61.6percent was macerated stillbirths. Yearly analysis of stillbirth rate did not clearly indicate whether stillbirth rate is increasing or declining. Not less than 56 primary obstetric causes of perinatal deaths were identified in this study. Many perinatal deaths were unexplainable due to lack of post-mortem. Idiopathic preterm labour was the main primary obstetric cause of early (34.5percent) and late neonatal (38.9percent) deaths, and the next was labour related intrapartum asphyxia. Labour related intrapartum asphyxia also accounts for 6.8percent of all stillbirths. The main known primary obstetric cause of stillbirth in the Hospital was Proteinuric hypertension/hypertension disorders. Over 60percent of perinatal mortality in Barberton Hospital was due to associated maternal conditions. Only 10.9percent was due to fetal related conditions and 26.4percent was unexplained. Few deaths were due to health system failure and domestic violence. Spontaneous preterm labour (18.4percent), abnormal labour or uterine rupture (14.5percent), maternal hypertension (12.4percent), antepartum haemorrhage (10.2percent) were the main associated maternal conditions causes of perinatal mortality in Barberton Hospital. Similarly, Fetal abnormality and infections were the main associated fetal condition causes of perinatal mortality. Of all the babies that were alive at birth, 85.2percent died due to maternal related conditions. Most neonates died due to spontaneous preterm labour (43.5percent) and abnormal labour or uterine rupture (23.1percent). Maternal HIV, diabetics and syphilis only accounted for a few neonatal deaths. For stillbirth babies that were alive at admission, abnormal labour or uterine rupture (33.1percent) and antepartum haemorrhage (19.7percent) were the main causes of their death. Over 60percent of all of macerated deaths have unexplained causes. Maternal hypertension is the main known cause of macerated stillbirth. For stillbirths that were dead on admission, maternal hypertension (13.1percent), antepartum haemorrhage (26.2percent) and abnormal labour or uterine rupture were the main causes of deaths. The majority of perinatal deaths in the hospital were caused by intrauterine deaths (58.8percent). Extreme multi-organ immaturity (13.1percent), Hyaline membrane disease (7.2percent) and Hypoxic ischaemic encephalopathy (5.2percent) were among the main final causes of perinatal deaths. The main behavioural factor causing perinatal mortality in Mpumalanga province was non-use of antenatal care services. The majority of perinatal mortality (60.4percent) was due to health system related causes. Most perinatal deaths were due to poor management of cases and delayed referral. Conclusion: The findings indicate that while stillbirths have slightly declined, neonatal deaths have not declined over the period. Perinatal have slightly declined in the hospital. The findings of this study also indicate that the majority of perinatal deaths in the hospital were caused by idiopathic preterm labour, unexplained intrauterine deaths, hypertension, and intrapartum asphyxia. Patient and health system related factors contributed significantly to perinatal deaths in the hospital. There is a need for yearly analysis of PPIP data to track progress and identify area for continuous improvement in provision of quality obstetric services. A greater community awareness of risk factors for perinatal deaths and importance of early and regular take up antenatal care services is needed.
- Full Text:
- Date Issued: 2018
- Authors: Modupe, Oluwarotimi Folorunsho
- Date: 2018
- Subjects: Newborn infants -- Mortality Perinatology
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/11254 , vital:37630
- Description: Background and aim: There is no doubt that the quantification of data on the new born is imperative towards the design of effective public health policy interventions. However, the trend in under-five mortality rates in Barberton Hospital is not recognised as no empirical investigation has been undertaken to ascertain its position in this regard. A trend analysis of infant and maternal deaths in will therefore shed light on possible factors influencing this trend. The specific objectives of this study were to examine the trend and causes of perinatal mortality in Barberton Hospital from 2002-2016. It was hypothesized that there would be a downward trend in the infant and maternal mortality rates in Barberton Hospital from 2002-2016, possibly as a result of improved medical care. Methods: This retrospective study was conducted in Barberton Hospital, located in the Umjindi sub-district in Mpumalanga Province. The data was drawn from the Perinatal Problem Identification Programme (PPIP) database. Pregnancy related deaths of women, and of children from birth to one year in Barberton Hospital from 1999-2014 were extracted. The population study consists of a record review of all infant and maternal deaths in Barberton Hospital from 2002-2016 and captured in the data on the PPIP. The University of Fort Hare ethical review committee approved the study protocol. In addition, permission to use the data was granted by the Mpumalanga Department of Health after applying for approval for use of the data for academic purposes. The data was then exported into an Excel format document and fed to Statistical Package for Social Sciences (SPSS) program to allow for a more detailed analysis. Results: Over the period under review (2002-2016), a total of 21151 babies were delivered, 20593 babies were alive at discharge, 221 babies died in the first 28 days of delivery, and 337 babies were stillbirths. 18577 were normal weight (≥2500gram), 1581 weighed 2000-2499 grams, 568 weighed 1500-1999grams, 286 weighed 1000-1499 and 139 weighed below 1000grams. All the women who gave birth over the period under review, 27.3percent tested positive to HIV, 40.3 percent tested negative. Of all women that tested positive, 80.2percent received any form of ART. For over half of women that received ART (n=2981), the type of ART they received is unknown. Most women whose baby died were young. One in five women did not have their age captured in the database indicating an important gap that need to be addressed in order to ensure integrity of the database. Of all the 558 perinatal mortality, 75.3 weighed below 2500 grams. Low birth weight is major risk factor for child mortality. Babies weighing less than 2,500 grams are 20 times more likely to die than heavier babies. For all the perinatal deaths, the majority of their mothers received antenatal care services. About 86.6percent were delivered at Barberton Hospital and only 1 child was delivered in transit to the hospital. Of all the 558 deaths, only 7.5 percent was multiple births. Of the 558 babies that died, only 39.6percent were born alive, 37.1percent was macerated stillbirths. The syphilis serology test indicated that most mothers tested negative. The HIV serology test indicated that 28percent of mothers tested positive. The hospital recorded a total of 337 stillbirths between 2002 and 2016. This accounts for 60.2percent of all perinatal mortality over the period. Of all stillbirths, 61.6percent was macerated stillbirths. Yearly analysis of stillbirth rate did not clearly indicate whether stillbirth rate is increasing or declining. Not less than 56 primary obstetric causes of perinatal deaths were identified in this study. Many perinatal deaths were unexplainable due to lack of post-mortem. Idiopathic preterm labour was the main primary obstetric cause of early (34.5percent) and late neonatal (38.9percent) deaths, and the next was labour related intrapartum asphyxia. Labour related intrapartum asphyxia also accounts for 6.8percent of all stillbirths. The main known primary obstetric cause of stillbirth in the Hospital was Proteinuric hypertension/hypertension disorders. Over 60percent of perinatal mortality in Barberton Hospital was due to associated maternal conditions. Only 10.9percent was due to fetal related conditions and 26.4percent was unexplained. Few deaths were due to health system failure and domestic violence. Spontaneous preterm labour (18.4percent), abnormal labour or uterine rupture (14.5percent), maternal hypertension (12.4percent), antepartum haemorrhage (10.2percent) were the main associated maternal conditions causes of perinatal mortality in Barberton Hospital. Similarly, Fetal abnormality and infections were the main associated fetal condition causes of perinatal mortality. Of all the babies that were alive at birth, 85.2percent died due to maternal related conditions. Most neonates died due to spontaneous preterm labour (43.5percent) and abnormal labour or uterine rupture (23.1percent). Maternal HIV, diabetics and syphilis only accounted for a few neonatal deaths. For stillbirth babies that were alive at admission, abnormal labour or uterine rupture (33.1percent) and antepartum haemorrhage (19.7percent) were the main causes of their death. Over 60percent of all of macerated deaths have unexplained causes. Maternal hypertension is the main known cause of macerated stillbirth. For stillbirths that were dead on admission, maternal hypertension (13.1percent), antepartum haemorrhage (26.2percent) and abnormal labour or uterine rupture were the main causes of deaths. The majority of perinatal deaths in the hospital were caused by intrauterine deaths (58.8percent). Extreme multi-organ immaturity (13.1percent), Hyaline membrane disease (7.2percent) and Hypoxic ischaemic encephalopathy (5.2percent) were among the main final causes of perinatal deaths. The main behavioural factor causing perinatal mortality in Mpumalanga province was non-use of antenatal care services. The majority of perinatal mortality (60.4percent) was due to health system related causes. Most perinatal deaths were due to poor management of cases and delayed referral. Conclusion: The findings indicate that while stillbirths have slightly declined, neonatal deaths have not declined over the period. Perinatal have slightly declined in the hospital. The findings of this study also indicate that the majority of perinatal deaths in the hospital were caused by idiopathic preterm labour, unexplained intrauterine deaths, hypertension, and intrapartum asphyxia. Patient and health system related factors contributed significantly to perinatal deaths in the hospital. There is a need for yearly analysis of PPIP data to track progress and identify area for continuous improvement in provision of quality obstetric services. A greater community awareness of risk factors for perinatal deaths and importance of early and regular take up antenatal care services is needed.
- Full Text:
- Date Issued: 2018
Assessment of the integrated HIV/AIDS curriculum at a university in the Eastern Cape: views of students and educators
- Terblanche, Delcia Jill Nora
- Authors: Terblanche, Delcia Jill Nora
- Date: 2018
- Subjects: AIDS (Disease) -- Study and teaching , AIDS (Disease) -- Prevention , Universities and colleges
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10353/12359 , vital:39256
- Description: Background: HIV/AIDS is a major global public health problem. The higher education sector too, is affected by the scourge of HIV/AIDS. Universities are considered to be high- risks areas for HIV infection because many students indulged in high risky behaviour link to HIV infection; therefore developing ways to prevent students for acquiring HIV and as well reducing HIV prevalence rates through training and teaching about HIV/AIDS will contribute to change in behaviour of students. Anecdotal evidence suggests that the majority of the students at Fort Hare lack the general awareness and education in HIV/AIDS due to lack of information coupled with their general disadvantaged background with the ultimate result being threatened by high infection rates. The University of Fort Hare (UFH), in a bid to capacitate the academic staff in respect of the laudable initiative to integrate HIV/AIDS in curricula, decided to embark on a pilot study that is anticipated to form fundamental strategies to sustainable HIV/AIDS curricula integration across all faculties, at least by the end of 2030. The university has planned to engage in the curriculum integration process by implementing a two year cycle pilot study during the grant period. Aim: The main aim of the study was to assess the challenges faced by students and educators concerning the integration and implementation of HIV/AIDS curriculum at the University of Fort Hare. Methods: The study adopted a quantitative, explorative descriptive design to examine the challenges associated with the Integrated HIV/AIDS curriculum at the University of Fort Hare. The target population was the educators and students who had training and teaching in the Integrated HIV/AIDS curriculum. A purposive sampling was used to select 487 students and 23 educators from across three departments: Nursing Science, LKA (Life, Knowledge and Action) and Law involved in the HIV/AIDS Curriculum Integration programme at the university. A self-design questionnaire was used for data collection focusing on the demographic profiles of the participants, the teaching strategies and methodologies adopted in the Integrated HIV/AIDS curriculum, the usefulness and relevance of the newly integrated HIV/AIDS curriculum content in addressing the needs of the students and the community, and the challenges faced by the educators and students in the Integrated HIV/AIDS curriculum. Ethical approved was obtained from the Research Ethics Committee of the University of Fort Hare. Permission was obtained from the participants through written consent forms. The data was analysed using descriptive statistics (frequency counts, percentage, means and standard deviations (SD)). The Chi-square test was used to examine the relationship between the variables of interest across the departments. A p-value of 0.05 was set for statistical significant testing. Results: The majority of the participants have adequate knowledge of HIV transmission, as 93.2 percent indicated HIV can be contracted through unprotected sex, sharing of needles (92.1 percent), receiving a blood transfusion that has not been screened for HIV (83.9 percent), sharing razor blades that has not been disinfected (83.0 percent), and having more than one sexual partner (86 percent). Age, gender, race and department were significantly associated with knowledge of route of HIV transmission. The present study indicated that the participants experienced several challenges during the teaching of the Integrated HIV/AIDS curriculum. Time allocated was the biggest challenge (58.3 percent), followed by undated materials, and curriculum overloading and teaching. The study indicated that majority of the students would like to compile a portfolio of evidence in the teaching of HIV, followed by creative arts, DVD/movies, and internet research. The majority of the lecturers preferred to teach HIV/AIDS through expressive arts, followed by role play, and formal lectures. The majority of the participants stated that HIV/AIDS information would be useful to them to apply in their communities and in their profession (97 percent), emphasizing that such knowledge and information will empower them to participate in roadshows and voluntary work at HIV/AIDS Shelters. The findings of this study pertaining to the challenges faced by educators during the implementation of the Integrated HIV/AIDS curriculum revealed that the majority of the participants stated that the HIV information was not updated, heavy workload, and adequate training. The lecturers expressed that they would prefer to teach HIV/AIDS curriculum by expressive art through drawing and creating art that expresses HIV and the relevance in the students’ community. Conclusions: Majority of the students received teaching of HIV as part of a course, and HIV teaching as an integrated component in a subject, while few received it as a stand-alone subject offered by a lecturer/facilitator. The present study indicated that the participants experienced several challenges during the teaching of the Integrated HIV/AIDS curriculum. Time allocated was the biggest challenge (58.3percent), followed by undated materials, and curriculum overloading and teaching. The majority of students preferred HIV/AIDS to be taught by their peers experience in HIV, by face-to face by a person who is HIV/AIDS infected or affected. The majority of the lecturers preferred to teach HIV/AIDS through expressive arts, followed by role play, and formal lectures. The majority of the participants affirmed the relevancy of HIV information taught. They further indicated that the information and knowledge gain would able them to make informed decisions on sexual behaviour. The majority of the participants stated that the HIV information was not updated, heavy workload, and adequate training. Most of the educators used formal lectures, followed by compilation of a portfolio of evidence, storytelling, DVD and movies, and experiential learning in hospitals and clinics in teaching HIV/AIDS integrated curriculum. The lecturers expressed that they would prefer to teach HIV/AIDS curriculum by expressive art through drawing and creating art that expresses HIV and the relevance in the students’ community. It is recommended that student’s involvement in the decision making processes of the integrated HIV/AIDS curriculum at the University of Fort Hare would make the programme more successful. HIV/AIDS resource materials need to be updated regularly and relevant to provide educators with specialized knowledge to be able to teach HIV/AIDS.
- Full Text:
- Date Issued: 2018
- Authors: Terblanche, Delcia Jill Nora
- Date: 2018
- Subjects: AIDS (Disease) -- Study and teaching , AIDS (Disease) -- Prevention , Universities and colleges
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10353/12359 , vital:39256
- Description: Background: HIV/AIDS is a major global public health problem. The higher education sector too, is affected by the scourge of HIV/AIDS. Universities are considered to be high- risks areas for HIV infection because many students indulged in high risky behaviour link to HIV infection; therefore developing ways to prevent students for acquiring HIV and as well reducing HIV prevalence rates through training and teaching about HIV/AIDS will contribute to change in behaviour of students. Anecdotal evidence suggests that the majority of the students at Fort Hare lack the general awareness and education in HIV/AIDS due to lack of information coupled with their general disadvantaged background with the ultimate result being threatened by high infection rates. The University of Fort Hare (UFH), in a bid to capacitate the academic staff in respect of the laudable initiative to integrate HIV/AIDS in curricula, decided to embark on a pilot study that is anticipated to form fundamental strategies to sustainable HIV/AIDS curricula integration across all faculties, at least by the end of 2030. The university has planned to engage in the curriculum integration process by implementing a two year cycle pilot study during the grant period. Aim: The main aim of the study was to assess the challenges faced by students and educators concerning the integration and implementation of HIV/AIDS curriculum at the University of Fort Hare. Methods: The study adopted a quantitative, explorative descriptive design to examine the challenges associated with the Integrated HIV/AIDS curriculum at the University of Fort Hare. The target population was the educators and students who had training and teaching in the Integrated HIV/AIDS curriculum. A purposive sampling was used to select 487 students and 23 educators from across three departments: Nursing Science, LKA (Life, Knowledge and Action) and Law involved in the HIV/AIDS Curriculum Integration programme at the university. A self-design questionnaire was used for data collection focusing on the demographic profiles of the participants, the teaching strategies and methodologies adopted in the Integrated HIV/AIDS curriculum, the usefulness and relevance of the newly integrated HIV/AIDS curriculum content in addressing the needs of the students and the community, and the challenges faced by the educators and students in the Integrated HIV/AIDS curriculum. Ethical approved was obtained from the Research Ethics Committee of the University of Fort Hare. Permission was obtained from the participants through written consent forms. The data was analysed using descriptive statistics (frequency counts, percentage, means and standard deviations (SD)). The Chi-square test was used to examine the relationship between the variables of interest across the departments. A p-value of 0.05 was set for statistical significant testing. Results: The majority of the participants have adequate knowledge of HIV transmission, as 93.2 percent indicated HIV can be contracted through unprotected sex, sharing of needles (92.1 percent), receiving a blood transfusion that has not been screened for HIV (83.9 percent), sharing razor blades that has not been disinfected (83.0 percent), and having more than one sexual partner (86 percent). Age, gender, race and department were significantly associated with knowledge of route of HIV transmission. The present study indicated that the participants experienced several challenges during the teaching of the Integrated HIV/AIDS curriculum. Time allocated was the biggest challenge (58.3 percent), followed by undated materials, and curriculum overloading and teaching. The study indicated that majority of the students would like to compile a portfolio of evidence in the teaching of HIV, followed by creative arts, DVD/movies, and internet research. The majority of the lecturers preferred to teach HIV/AIDS through expressive arts, followed by role play, and formal lectures. The majority of the participants stated that HIV/AIDS information would be useful to them to apply in their communities and in their profession (97 percent), emphasizing that such knowledge and information will empower them to participate in roadshows and voluntary work at HIV/AIDS Shelters. The findings of this study pertaining to the challenges faced by educators during the implementation of the Integrated HIV/AIDS curriculum revealed that the majority of the participants stated that the HIV information was not updated, heavy workload, and adequate training. The lecturers expressed that they would prefer to teach HIV/AIDS curriculum by expressive art through drawing and creating art that expresses HIV and the relevance in the students’ community. Conclusions: Majority of the students received teaching of HIV as part of a course, and HIV teaching as an integrated component in a subject, while few received it as a stand-alone subject offered by a lecturer/facilitator. The present study indicated that the participants experienced several challenges during the teaching of the Integrated HIV/AIDS curriculum. Time allocated was the biggest challenge (58.3percent), followed by undated materials, and curriculum overloading and teaching. The majority of students preferred HIV/AIDS to be taught by their peers experience in HIV, by face-to face by a person who is HIV/AIDS infected or affected. The majority of the lecturers preferred to teach HIV/AIDS through expressive arts, followed by role play, and formal lectures. The majority of the participants affirmed the relevancy of HIV information taught. They further indicated that the information and knowledge gain would able them to make informed decisions on sexual behaviour. The majority of the participants stated that the HIV information was not updated, heavy workload, and adequate training. Most of the educators used formal lectures, followed by compilation of a portfolio of evidence, storytelling, DVD and movies, and experiential learning in hospitals and clinics in teaching HIV/AIDS integrated curriculum. The lecturers expressed that they would prefer to teach HIV/AIDS curriculum by expressive art through drawing and creating art that expresses HIV and the relevance in the students’ community. It is recommended that student’s involvement in the decision making processes of the integrated HIV/AIDS curriculum at the University of Fort Hare would make the programme more successful. HIV/AIDS resource materials need to be updated regularly and relevant to provide educators with specialized knowledge to be able to teach HIV/AIDS.
- Full Text:
- Date Issued: 2018
Factors contributing to non-adherence in HIV positive patients on antiretroviral treatment in primary health care facilities, East London, Eastern Cape
- Authors: Petse, Siphokazi
- Date: 2018
- Subjects: Antiretroviral therapy -- Eastern Cape -- South Africa , Patient compliance , HIV-positive persons -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10353/9734 , vital:34905
- Description: Aim: South Africa is faced with the major challenge of ensuring and sustaining the quality of services, including preventing and managing side- effects, and improving drug adherence, which are all critical, for the success of a comprehensive HIV programme. The aim of this study was to examine the underlying contributing factors to antiretroviral treatment adherence among HIV positive patients attending primary health care facilities in East London. Methods: This was a descriptive cross-sectional study involving 371 HIV positive patients on antiretroviral treatment in xx primary health care facilities in East London, South Africa. The study utilized a self- designed structured questionnaire with both open- ended and closed ended questions, divided into socio-demographic, socio- economic, level of understanding and knowledge on HIV, quality of care and waiting times. Results: About 64 percent of the participants had a good knowledge of HIV, 25 percent had an average knowledge with few participants having poor knowledge of HIV (11 percent). Majority (92.2 percent) were counselled before starting ARVs treatment. Majority of participants (70.7 percent) do have money for transport to come to the clinic, while 53.1 percent experienced side effects. The majority (70 percent) of the participants were non-adherents. Concerning viral load distribution, 52 percent were undetectable, 26 percent unsuppressed and 22 percent suppressed. Marital status (married) (p=0.005), having no formal education (p=0.035), being Christian (p=0.007), alcohol consumption (p= 0.021) and viral load suppression had significant association with non-adherence to ARV treatment among participants. After adjusting for confounders, only non-Christians and unsuppressed viral loads were the independent predictors of non-adherence. Conclusion: The main contributing factors to ART non-adherence among participants on ARVs were marital status, level of education, religion, and Christians were more adherent to the treatment than non-Christians. Alcohol consumption also contributed to non-adherence and viral load. Adherence counseling should be done on each and every visit to remind the participants on the importance of taking their treatment. These factors need to be addressed to improve adherence to the treatment, decrease the virus in the blood (viral load) and improve their health in general.
- Full Text:
- Date Issued: 2018
- Authors: Petse, Siphokazi
- Date: 2018
- Subjects: Antiretroviral therapy -- Eastern Cape -- South Africa , Patient compliance , HIV-positive persons -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10353/9734 , vital:34905
- Description: Aim: South Africa is faced with the major challenge of ensuring and sustaining the quality of services, including preventing and managing side- effects, and improving drug adherence, which are all critical, for the success of a comprehensive HIV programme. The aim of this study was to examine the underlying contributing factors to antiretroviral treatment adherence among HIV positive patients attending primary health care facilities in East London. Methods: This was a descriptive cross-sectional study involving 371 HIV positive patients on antiretroviral treatment in xx primary health care facilities in East London, South Africa. The study utilized a self- designed structured questionnaire with both open- ended and closed ended questions, divided into socio-demographic, socio- economic, level of understanding and knowledge on HIV, quality of care and waiting times. Results: About 64 percent of the participants had a good knowledge of HIV, 25 percent had an average knowledge with few participants having poor knowledge of HIV (11 percent). Majority (92.2 percent) were counselled before starting ARVs treatment. Majority of participants (70.7 percent) do have money for transport to come to the clinic, while 53.1 percent experienced side effects. The majority (70 percent) of the participants were non-adherents. Concerning viral load distribution, 52 percent were undetectable, 26 percent unsuppressed and 22 percent suppressed. Marital status (married) (p=0.005), having no formal education (p=0.035), being Christian (p=0.007), alcohol consumption (p= 0.021) and viral load suppression had significant association with non-adherence to ARV treatment among participants. After adjusting for confounders, only non-Christians and unsuppressed viral loads were the independent predictors of non-adherence. Conclusion: The main contributing factors to ART non-adherence among participants on ARVs were marital status, level of education, religion, and Christians were more adherent to the treatment than non-Christians. Alcohol consumption also contributed to non-adherence and viral load. Adherence counseling should be done on each and every visit to remind the participants on the importance of taking their treatment. These factors need to be addressed to improve adherence to the treatment, decrease the virus in the blood (viral load) and improve their health in general.
- Full Text:
- Date Issued: 2018
Knowledge, attitudes and practice of professional nurses regarding organ donation in critical care units of public and private hospitals in Eastern Cape Province
- Authors: Green, Bukelwa
- Date: 2018
- Subjects: Organ donors--Supply and demand Donation of organs, tissues, etc Transplantation of organs, tissues
- Language: English
- Type: Thesis , Masters , Magister Curationis
- Identifier: http://hdl.handle.net/10353/11116 , vital:37138
- Description: Globally there is an overwhelming increase in the number of patients waiting for donated organs for transplantation, with a gross shortage of available organs. There are many contributing factors to this dearth of donated organs, including level of knowledge, cultural beliefs, lack of clear practice and the attitudes of health care providers, as the gatekeepers of the health system. This non-experimental research study assessed the attitudes, level of knowledge, and practices of professional nurses working in critical care units in public and private hospitals in Eastern Cape Province regarding organ donation. The study was conducted in both private and public hospital intensive care and renal care units. The targeted population in the study was professional nurses working in intensive and renal care units, trained in critical care or nephrology, as well as those who were not trained but working in these specialised areas. The non-probability, purposive sampling method was employed and total population was 187 professional nurses working in public and private critical care units but only 108 managed to yield data for this study. Data was collected with anonymous, self - developed questionnaires. The questionnaire was submitted to supervisors and statistician for validity. Reliability was established by conducting pretest of the instrument, which yielded positive results because all questionnaires were correctly completed.Data captured and analysed using the Statistical Package for Social Sciences (SPSS) software for Windows version 22 and is presented by means of percentages and tables. Results: The findings were that, there is insufficient knowledge on the topic of organ donation, with subsequent inadequate practice, which derives from lack of pre-registration training and ongoing in-service education regarding the topic. The unavailability of full organ transplantation services in the province is viewed as a hindrance in the practice of organ donation. There was generally a positive attitude towards organ donation, particularly among Christian nurses. The knowledge deficit and limited practice seem not to have affected the attitudes of the participants, who supported the idea of organ donation. However, despite the positive attitudes, only 13 participants (12.0 percent) agreed to be registered as organ donors. 50 percent of participants lacked knowledge about availability and contact details of the provincial organ donation foundation, which may indicate inadequate marketing on the part of the foundation. There was no significant difference in knowledge, attitudes and practice between nurses in the private and public sectors. Rather differences were noted between the different levels of health care services, i.e. between the secondary and tertiary level. The tertiary level outperformed the secondary level institutions. It is recommended that organ donation be incorporated into the syllabi of health sciences courses both in universities and colleges, and that awareness campaigns be strengthened.
- Full Text:
- Date Issued: 2018
- Authors: Green, Bukelwa
- Date: 2018
- Subjects: Organ donors--Supply and demand Donation of organs, tissues, etc Transplantation of organs, tissues
- Language: English
- Type: Thesis , Masters , Magister Curationis
- Identifier: http://hdl.handle.net/10353/11116 , vital:37138
- Description: Globally there is an overwhelming increase in the number of patients waiting for donated organs for transplantation, with a gross shortage of available organs. There are many contributing factors to this dearth of donated organs, including level of knowledge, cultural beliefs, lack of clear practice and the attitudes of health care providers, as the gatekeepers of the health system. This non-experimental research study assessed the attitudes, level of knowledge, and practices of professional nurses working in critical care units in public and private hospitals in Eastern Cape Province regarding organ donation. The study was conducted in both private and public hospital intensive care and renal care units. The targeted population in the study was professional nurses working in intensive and renal care units, trained in critical care or nephrology, as well as those who were not trained but working in these specialised areas. The non-probability, purposive sampling method was employed and total population was 187 professional nurses working in public and private critical care units but only 108 managed to yield data for this study. Data was collected with anonymous, self - developed questionnaires. The questionnaire was submitted to supervisors and statistician for validity. Reliability was established by conducting pretest of the instrument, which yielded positive results because all questionnaires were correctly completed.Data captured and analysed using the Statistical Package for Social Sciences (SPSS) software for Windows version 22 and is presented by means of percentages and tables. Results: The findings were that, there is insufficient knowledge on the topic of organ donation, with subsequent inadequate practice, which derives from lack of pre-registration training and ongoing in-service education regarding the topic. The unavailability of full organ transplantation services in the province is viewed as a hindrance in the practice of organ donation. There was generally a positive attitude towards organ donation, particularly among Christian nurses. The knowledge deficit and limited practice seem not to have affected the attitudes of the participants, who supported the idea of organ donation. However, despite the positive attitudes, only 13 participants (12.0 percent) agreed to be registered as organ donors. 50 percent of participants lacked knowledge about availability and contact details of the provincial organ donation foundation, which may indicate inadequate marketing on the part of the foundation. There was no significant difference in knowledge, attitudes and practice between nurses in the private and public sectors. Rather differences were noted between the different levels of health care services, i.e. between the secondary and tertiary level. The tertiary level outperformed the secondary level institutions. It is recommended that organ donation be incorporated into the syllabi of health sciences courses both in universities and colleges, and that awareness campaigns be strengthened.
- Full Text:
- Date Issued: 2018
Relationship between alcohol use patterns and knowledge of alcohol-attributable health conditions among undergraduate students' at a university in the Eastern Cape
- Authors: Mandeya, Andrew
- Date: 2018
- Subjects: Drinking of alcoholic beverages College students--Alcohol use
- Language: English
- Type: Thesis , Masters , Public Health
- Identifier: http://hdl.handle.net/10353/11128 , vital:37173
- Description: Background: Alcohol use prevalence has been found to be higher than 50 percent at some universities in South Africa. It is against this background that this study aimed to establish the relationship between alcohol use, knowledge of alcohol-attributable health conditions and biographical characteristics. Literature review: The study was based on a review of literature on prevalence and patterns of alcohol use among university students, knowledge of alcohol-attributable chronic diseases, foetal alcohol syndrome, sexual and reproductive health and alcohol use measurement. Methodology: Data were collected from 213 undergraduate students enrolled for the Statistics service courses on two campuses of the same university. The Mann-Whitney normal approximation and the Kruskal-Wallis tests were used to compare health knowledge across levels of alcohol use and biographical characteristics. The chi-squared test and multiple logistic regression analysis were used to determine the significance and patterns of associations between alcohol use and health knowledge and biographical characteristics. Results: The prevalence rates of alcohol use and risky alcohol use were found to be 58.2 percent and 42.7 percent, respectively. The mean health knowledge was 42.9 percent, which, is rather low. Males [OR=0.3; 95 percentCI (0.18; 0.68)], returning students [OR=0.5; 95 percentCI (0.25; 0.94)] and those with employed fathers [OR=2.3; 95 percentCI (1.19; 4.47)] were found to be at a higher risk of alcohol use. Health knowledge was significantly higher among alcohol users (Z=-2.7; p=0.0074) and those whose fathers had a post matric education (𝜒2=6.4; p=0.0410) and/or employment (Z=-2.7; p=0.0064). Conclusion: While prevalence rates of alcohol use and risky alcohol were high, health knowledge was disappointingly low. This suggests need for interventions designed to minimise alcohol use while at the same time increasing health knowledge.
- Full Text:
- Date Issued: 2018
- Authors: Mandeya, Andrew
- Date: 2018
- Subjects: Drinking of alcoholic beverages College students--Alcohol use
- Language: English
- Type: Thesis , Masters , Public Health
- Identifier: http://hdl.handle.net/10353/11128 , vital:37173
- Description: Background: Alcohol use prevalence has been found to be higher than 50 percent at some universities in South Africa. It is against this background that this study aimed to establish the relationship between alcohol use, knowledge of alcohol-attributable health conditions and biographical characteristics. Literature review: The study was based on a review of literature on prevalence and patterns of alcohol use among university students, knowledge of alcohol-attributable chronic diseases, foetal alcohol syndrome, sexual and reproductive health and alcohol use measurement. Methodology: Data were collected from 213 undergraduate students enrolled for the Statistics service courses on two campuses of the same university. The Mann-Whitney normal approximation and the Kruskal-Wallis tests were used to compare health knowledge across levels of alcohol use and biographical characteristics. The chi-squared test and multiple logistic regression analysis were used to determine the significance and patterns of associations between alcohol use and health knowledge and biographical characteristics. Results: The prevalence rates of alcohol use and risky alcohol use were found to be 58.2 percent and 42.7 percent, respectively. The mean health knowledge was 42.9 percent, which, is rather low. Males [OR=0.3; 95 percentCI (0.18; 0.68)], returning students [OR=0.5; 95 percentCI (0.25; 0.94)] and those with employed fathers [OR=2.3; 95 percentCI (1.19; 4.47)] were found to be at a higher risk of alcohol use. Health knowledge was significantly higher among alcohol users (Z=-2.7; p=0.0074) and those whose fathers had a post matric education (𝜒2=6.4; p=0.0410) and/or employment (Z=-2.7; p=0.0064). Conclusion: While prevalence rates of alcohol use and risky alcohol were high, health knowledge was disappointingly low. This suggests need for interventions designed to minimise alcohol use while at the same time increasing health knowledge.
- Full Text:
- Date Issued: 2018
Risk factors of cardio-metabolic diseases among student nurses at Lilitha College of Nursing, East London, South Africa
- Authors: Mkanzi, Noluthando
- Date: 2018
- Subjects: Risk assessment Cardiovascular system -- Diseases Human physiology
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10353/12924 , vital:39404
- Description: Background: Non-communicable diseases are a growing public health concern and its prevalence is escalating exponentially, with a high frequency of morbidity, premature mortality, disability and loss of productivity. Since health education has become an important part of medical care, student nurses are potentially well suited to assist with the combat of these diseases. Early identification and treatment of modifiable risk factors among young adults would reduce the risk of developing cardio-metabolic diseases, thus, promoting health, prolonging life as well as saving costs related to healthcare. Objective: This study aimed to investigate the prevalence of cardio-metabolic risk factors among student nurses. Method: This was a descriptive cross sectional study, involving a convenience sample of 228 students during the educational year of 2017-2018 at Lilitha Collegeof Nursing in East London, South Africa. The WHO STEPwise standardized questionnaire was used to collect information on socio-demographic data (age, gender, year of study) and behavioural characteristics (smoking, alcohol consumption, physical inactivity, and dietary intake) of the participants. Anthropometric screening included measurement of height, weight and waist circumference. The biochemical screening included measurement of blood pressure and determination of fasting blood glucose concentration. Only students with complete data set were included in the data analysis. Statistical Package for Social Science (SPSS) version 23.0 was employed for descriptive and inferential analysis. Results: About half (41.7 percent) of the study participants were between the ages of 21 to 25 years and majority were females (67.5 percent).The prevalence of overweight and obesity were found to be 33 percent and 44 percent respectively. The prevalence of overweight was higher in males (44.6 percent), while females (53.9 percent) had higher prevalence of obesity. Female gender and increasing age are the only independent predictors of obesity. Results on blood pressure measurement showed that 25 percent of the participants had elevated blood pressure, and 22 percent were on stage 1 of hypertension while 2 percent were on stage 2. According to Joint National Committee on hypertension (JNC)’s criteria for defining hypertension, 44 percent of the participants had pre hypertension and 11percent had hypertension, diabetes and vegetables consumption were statistically associated with hypertension. The prevalence of pre-diabetes and diabetes was 6 percent and 7 percent respectively. Only abdominal obesity measured by waistto- hip ratio had a significant relationship with diabetes. Just 4.8 percent of the participants smoked daily and 33.3 percent consumed alcohol. Regarding physical activity, males were more active (60.8 percent) compared to females (54.8 percent). Conclusion: A high burden of overweight, obesity, and physical inactivity was observed among student nurses in East London. Screening for cardio-metabolic risk factors (CMRFs) among nursing students and implementation of intervention programs are recommended. Programs to raise awareness about CMRFs, encourage young adult students to adopt a healthy dietary behaviour and promote physical exercise should be initiated.
- Full Text:
- Date Issued: 2018
- Authors: Mkanzi, Noluthando
- Date: 2018
- Subjects: Risk assessment Cardiovascular system -- Diseases Human physiology
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10353/12924 , vital:39404
- Description: Background: Non-communicable diseases are a growing public health concern and its prevalence is escalating exponentially, with a high frequency of morbidity, premature mortality, disability and loss of productivity. Since health education has become an important part of medical care, student nurses are potentially well suited to assist with the combat of these diseases. Early identification and treatment of modifiable risk factors among young adults would reduce the risk of developing cardio-metabolic diseases, thus, promoting health, prolonging life as well as saving costs related to healthcare. Objective: This study aimed to investigate the prevalence of cardio-metabolic risk factors among student nurses. Method: This was a descriptive cross sectional study, involving a convenience sample of 228 students during the educational year of 2017-2018 at Lilitha Collegeof Nursing in East London, South Africa. The WHO STEPwise standardized questionnaire was used to collect information on socio-demographic data (age, gender, year of study) and behavioural characteristics (smoking, alcohol consumption, physical inactivity, and dietary intake) of the participants. Anthropometric screening included measurement of height, weight and waist circumference. The biochemical screening included measurement of blood pressure and determination of fasting blood glucose concentration. Only students with complete data set were included in the data analysis. Statistical Package for Social Science (SPSS) version 23.0 was employed for descriptive and inferential analysis. Results: About half (41.7 percent) of the study participants were between the ages of 21 to 25 years and majority were females (67.5 percent).The prevalence of overweight and obesity were found to be 33 percent and 44 percent respectively. The prevalence of overweight was higher in males (44.6 percent), while females (53.9 percent) had higher prevalence of obesity. Female gender and increasing age are the only independent predictors of obesity. Results on blood pressure measurement showed that 25 percent of the participants had elevated blood pressure, and 22 percent were on stage 1 of hypertension while 2 percent were on stage 2. According to Joint National Committee on hypertension (JNC)’s criteria for defining hypertension, 44 percent of the participants had pre hypertension and 11percent had hypertension, diabetes and vegetables consumption were statistically associated with hypertension. The prevalence of pre-diabetes and diabetes was 6 percent and 7 percent respectively. Only abdominal obesity measured by waistto- hip ratio had a significant relationship with diabetes. Just 4.8 percent of the participants smoked daily and 33.3 percent consumed alcohol. Regarding physical activity, males were more active (60.8 percent) compared to females (54.8 percent). Conclusion: A high burden of overweight, obesity, and physical inactivity was observed among student nurses in East London. Screening for cardio-metabolic risk factors (CMRFs) among nursing students and implementation of intervention programs are recommended. Programs to raise awareness about CMRFs, encourage young adult students to adopt a healthy dietary behaviour and promote physical exercise should be initiated.
- Full Text:
- Date Issued: 2018
Women's knowledge and attitudes towards discontinuation of the Long-acting reversible contraceptive (Implanon) in Buffalo City Municipality, South Africa
- Authors: Mrwebi, Khungelwa Patricia
- Date: 2018
- Subjects: Contraceptives Birth control Women's health services
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/11206 , vital:37231
- Description: Unintended pregnancy remains a public health concern worldwide despite the availability of many contraceptives options. The South Africa Government introduced Implanon —a Long-acting Reversible Device— with aim to cost effectively prevent unplanned pregnancy. There are concerns that the implementation of this contraceptive option was without prior piloting to test for level of acceptance and attitude towards this contraception. Also, there is paucity of evidence on knowledge of women and their attitude to implanon as well as duration of use and reasons for discontinuation of implanon in South Africa. The present study address this gap by assessing the women’s knowledge of and attitude to implanon as well as reasons for implanon discontinuation in Buffalo City Municipality in South Africa. This prospective observational study administered a pre-validated questionnaire to 189 women who had removed implanon in the reproductive health clinic in one regional hospital and a primary health centre in Buffalo City Municipality. Descriptive statistics were used to analysis the study data. The average duration for implanon use among the participants was 11.2 months. Most participants had poor knowledge of implanon and implanon knowledge was significantly associated was with age. Most participants opined that implanon use is associated with heavy bleeding (60.7), irregular frequent bleeding (84.3percent), and weight gain (67percent). The main reason for implanon discontinuation was its side effects (71.3 percent). Other reasons for discontinuation of implanon are poor or wrong positioning (3.2percent), want to become pregnant (4.3percent). Some participants discontinued implanon because they were on treatment; 24 participants on ARV drug, one on antipsychotic drugs, and one on TB drugs. Experience of heavy bleeding (39.9percent) was the most stated side of implanon leading to implanon discontinuation. The study concluded that women, even though adopted implanon, lack knowledge of implanon mechanism of action and side effects. Poor knowledge of implanon side effects could explain its early discontinuation among women in South Africa. Provider should prioritise comprehensive counselling of clients on implanon side effects and mechanism of action in order to realise the benefit of implanon in this population.
- Full Text:
- Date Issued: 2018
- Authors: Mrwebi, Khungelwa Patricia
- Date: 2018
- Subjects: Contraceptives Birth control Women's health services
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/11206 , vital:37231
- Description: Unintended pregnancy remains a public health concern worldwide despite the availability of many contraceptives options. The South Africa Government introduced Implanon —a Long-acting Reversible Device— with aim to cost effectively prevent unplanned pregnancy. There are concerns that the implementation of this contraceptive option was without prior piloting to test for level of acceptance and attitude towards this contraception. Also, there is paucity of evidence on knowledge of women and their attitude to implanon as well as duration of use and reasons for discontinuation of implanon in South Africa. The present study address this gap by assessing the women’s knowledge of and attitude to implanon as well as reasons for implanon discontinuation in Buffalo City Municipality in South Africa. This prospective observational study administered a pre-validated questionnaire to 189 women who had removed implanon in the reproductive health clinic in one regional hospital and a primary health centre in Buffalo City Municipality. Descriptive statistics were used to analysis the study data. The average duration for implanon use among the participants was 11.2 months. Most participants had poor knowledge of implanon and implanon knowledge was significantly associated was with age. Most participants opined that implanon use is associated with heavy bleeding (60.7), irregular frequent bleeding (84.3percent), and weight gain (67percent). The main reason for implanon discontinuation was its side effects (71.3 percent). Other reasons for discontinuation of implanon are poor or wrong positioning (3.2percent), want to become pregnant (4.3percent). Some participants discontinued implanon because they were on treatment; 24 participants on ARV drug, one on antipsychotic drugs, and one on TB drugs. Experience of heavy bleeding (39.9percent) was the most stated side of implanon leading to implanon discontinuation. The study concluded that women, even though adopted implanon, lack knowledge of implanon mechanism of action and side effects. Poor knowledge of implanon side effects could explain its early discontinuation among women in South Africa. Provider should prioritise comprehensive counselling of clients on implanon side effects and mechanism of action in order to realise the benefit of implanon in this population.
- Full Text:
- Date Issued: 2018
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